I’m Glad You Asked, Ms. Verma: Five Ways to Make Healthcare More Efficient

Last year CMS solicited ideas from regular Americans on how to make healthcare more efficient. Here’s my five cents.

Recently, Centers for Medicare and Medicaid Services Administrator Seema Verma penned an op-ed casting a vision for a free-market, patient-centered healthcare system. In it, she echoes the Administration’s populist ideals, writing, “We will move away from the assumption that Washington can engineer a more efficient health-care system from afar,” adding, “Patients can define value better than the federal government can.”

I agree. In my opinion, individuals tend to make better, more informed decisions about their health than bureaucrats, and a system that esteems the doctor-patient relationship should ultimately improve health outcomes and reduce waste. Fortunately for Verma, despite its many flaws, the ACA’s explicit focus on patient-centered care leaves room for significant innovation in this space. That’s likely why, recognizing the long odds on the passage of Graham-Cassidy, Verma called on individuals and organizations to submit ideas for how CMS can embrace innovation and avoid its looming financial collapse while driving decision-making to the lowest levels of the system. Since she asked, here’s my take:

1. Address comorbidity

While a staggering 86 percent of healthcare spending is for patients with one or more chronic condition, fully 71 percent is spent on the third of Americans managing multiple chronic conditions, according to the HHS. No doubt the CMS Innovation Center’s programs focusing on singular diseases like diabetes or hypertension have merit and warrant investment, but effective patient-centered care must examine and address the complexities of comorbidity, rather than treating diseases in isolation.

2. Acknowledge that care encompasses more than a person’s health

The vast majority of disease management programs and wellness initiatives rely on medical and pharmacy claims to drive enrollment and evaluate success. More progressive programs add real-time biometric data to the mix, but what most don’t address are the multiple, less-observable social determinants of health: housing, food insecurity and employment to name a few. Patient-centered initiatives must recognize the interdependent nature of a person’s health and must make meaningful connections between and among providers beyond the traditional healthcare market.

3. Embrace technology

Technology will obviously play an integral role in delivering quality, individualized care. Advances in genomics, machine learning, natural language technology, and AI portend the inevitable ascension of precision medicine, an effort to intervene and treat individual patients based on \ their unique genetic markers and copious biometric data.

Telemedicine, too, has a role to play. At the same time store-and- forward, real-time video, and rPM technologies are expanding the reach of quality disease management programming, they are also supporting the notable shift toward patient-centered care.

4. Incentivize disruptive small-scale pilot programs

According to a 2012 study, 75 percent of venture-backed startups fail. Given the magnitude and complexity of the industry, an even lower success rate among healthcare startups wouldn’t be surprising, but we won’t know unless we try. And we can’t try if startups can’t penetrate medical systems. And hospital networks and insurance giants won’t invite startups to the table unless they are incentivized to do so. CMS (and HHS and CDC) would be well served turning to startups to solve the complex set of challenges patient centered care presents. Start small. Prove concepts. Double down.

5. Promote geo-targeted health services

If all politics is local, then healthcare and politics have at least one thing in common. Until the full promise of 100 percent individualized medicine is realized, there’s both logic and value in considering geography as part of the slow shift toward patient-centered care. The factors affecting a person’s health are often rooted in the communities in which he or she lives. These environmental, social, economic, and behavioral health determinants, along with the local factors influencing the quality, cost and provider accessibility matter and have a dramatic impact on health outcomes. Geo-targeting is among the simplest ways to leverage big health data in an effort to shift medicine away from a one- size-fits- all approach.

Regardless of whether the ACA succeeds or collapses under its own weight, the emergence of healthcare system imbued with flexibility and the capacity to identify and respond to individual cues will require unprecedented innovation, input from unlikely sources, and perhaps a few well- positioned risk takers willing to disrupt existing models. For seeking input, Seema Verma is to be applauded.

“No central planner gave Henry Ford a set of rules and instructions to manufacture the Model T. His ingenuity led to the product, and millions of consumers chose to buy it,” writes Verma in the op-ed. With 28 million people in the U.S. still uninsured, let’s hope for ingenuity on an equal scale.